Mindfulness, it gets everywhere. From mental health services, to schools and into the House of Commons pupils, prisoners and politicians are taking a breath, holding that thought and just…noticing. It begins to feel like Woody Allen’s vision of 1970s New York, where everyone is in psychoanalysis. Mindfulness is not just a new form of treatment, it is a way of life for growing numbers of people.
I must confess to some desire to provoke in choosing the title for this post. I am no more ‘against’ mindfulness than I am against psychotherapy, formulation or exercise. Mindfulness evidently has a place in the spiritual lives of many, and in mental health services, as a form of anxiety reduction, as a way to get people in touch with their inner world, as a way to manage the agony that some people feel in simply being alive. However, what I am against is a certain breed of unbridled enthusiasm that can make innovations like Mindfulness seem like they are not only magically transformative but also mandatory. Despite the reserve of its promoters (on full and worthy display in the excellent Guardian article here) the way Mindfulness is spoken about, written about and thought about suggests caution has been thrown increasingly to the wind.
Psychotherapeutic innovations, much like medical innovations, travel on a wing and a prayer. We try something out for X and find it helpful, so it makes good sense to consider applying it to Y. It is no wonder that Mindfulness has moved from being a way to manage >stress and illness, to being a component of major treatment for borderline personality to being a >depression intervention and way beyond.
There is talk of a move toward the use of Mindfulness in the treatment of psychosis. When Peter Liddle and his colleagues found an association between psychosis and a disruption to the insula-frontal loop that regulates salience, it was suggested Mindfulness might play a role in boosting insula function if practiced hard enough to increase the density of the brain. It’s early days yet, and one can easily imagine that the capacity to differentiate different internal states could be very beneficial for people in whom this capacity gets disrupted. However, given that psychosis has long been theorised as a breakdown in the basic integrity of the sense of self (see here for a phenomenological account and hereone focused more on cognitive neuroscience), the deployment of an intervention that promotes further flight from the ego seems to me to be a step we should be taking very cautiously indeed.
Awareness of one’s existential states is not unique to Mindfulness, it has a rich tradition in psychoanalytic and phenomenological psychology and is a wonderful autonomy granting thing. The integrative psychotherapist Paul Wachtel has suggested that, in terms of self-observation, there is a huge overlap between the internal mental focus of psychoanalysis and the focused breathing activities of behavioural anxiety reduction. So why has this Buddhist variant been such a smashing success recently? A sceptic might suggest an element of faddism, and I would humbly submit they could be onto something. This is not to say there is anything faddish about regular meditative practice, it’s strenuous and disciplined, for at least some proportion of the people who undertake it.
Mindfulness appears superficially to sit quite well with a holistic and political approach to mental health, but it also promotes a degree of distance from emotion. This distance can be invaluable, but there are emotions, even quite unpleasant ones, whose force it can be worth retaining. Emotions are our lifeblood, the fuel for our internal moral engines. ‘What’s that you say, you’ve furious because you live in a structurally unfair society?…..And breathe.’
This is all somewhat facetious; the obvious reply is that if Mindfulness detaches you from your emotions then it is not to nearly the same extent as psychoactive medications. Quite right; my point is that if one part of mental health care is helping us get some distance from our emotions, another part is helping us get back in touch with them. This point has been made in the field of politics, where it is argued (most often by revolutionary Marxists, it has to be said) that cultivating a radical acceptance could also induce an unhealthy degree of apathy. In short, acquiring Mindfulness about disabling levels of anger, terror or regret may be the easy part. If it were all your psychologist had to offer, you might reasonably feel short changed.
Mindfulness, it is often said, is partly about getting in touch with the fact there is no basic self. Some cognitive scientists feel similarly, but barring any sudden metaphysical breakthroughs, we can safely say that the issue is moot. Personally I rather like having a self, and for the time being my university, my family and the taxman all seem to agree it exists (try arguing it wasn’t you that spent all that money on cake last month). There is something like a Huw there, I may as well get to know him.
My own relationship with Mindfulness is of course coloured by my personal tastes. Inner awareness can also come from therapy, from conversation and in the form of extended daydreaming and reverie; the fascination of realising ‘oh that pissed me off, I wonder why?’ and the tremendous power of not reacting on impulse. I have spent quite a lot of time in my own head over the course of my life and with that has come a distance from immediate reactions, which has often served me well. We should strive to maintain the deepest respect for people’s relationships with their minds, however religious, secular or simply idiosyncratic they may be. The question for the psychologist is how to engage with different approaches to life without ever becoming proselytisers.
Mindfulness arises out of an ancient theological system far more complex than can possibly be credited in the numerous books that now fill the self help sections. The current western fashion does something rather tawdry to this historical legacy, seeming to don it as easily as a cheap pashmina. I have no principled stance against the secular appropriation of religious activities (I celebrate a fairly Godless Christmas), but many of the now widespread uses of Mindfulness, and of Buddhism in general, leave me cold.